Peptic ulcers are sores that develop in the lining of the esophagus, stomach, or upper section of the small intestine (duodenum). The stomach is a strong, muscular organ that grinds and crushes food, in combination with digestive juices such as hydrochloric acid, bile acids, and enzymes, including pepsin. A mucus layer coats the interior of the stomach, protecting it from the digestive juices. Prostaglandins, hormone-like substances involved in muscle contraction, also protect the lining. Any imbalance in the production of these digestive juices can damage the lining of the stomach and form an open sore called an ulcer.

There are two types of peptic ulcers: gastric ulcers (stomach ulcer) and duodenal ulcers (first segment of the intestine).

Infection with H. pylori is common, especially in developing countries, with up to 50% of the world's population infected. It is believed to be transmitted by eating contaminated food or drinking water or possibly through direct contact with the stool, vomit, or saliva of an infected person. For reasons that are not yet understood, H. pylori does not cause ulcers in all who are infected; however, of those who do have peptic ulcers, more than half are caused by this infection.

Another common cause of peptic ulcers is long-term use of NSAIDs such as aspirin, naproxen, and ibuprofen. Individuals who take NSAIDs every day or several times a week, especially if they are age 70 or older or have had a prior ulcer, are more likely to develop peptic ulcers. Women are more likely than men to develop an ulcer due to NSAIDs.

Rarely, peptic ulcers can be caused by the condition Zollinger-Ellison Syndrome, in which there is increased production of the hormone gastrin due to a tumor in the pancreas or small intestine.

Drinking alcohol in excess and smoking can make peptic ulcers worse and prevent healing.

A stool sample may be collected to look for the H. pylori antigen; however, this test is not appropriate for individuals who have blood in their stool.

A breath test known as the "urea breath test" is also available and detects the enzyme produced by H. pylori.

A blood test for H. pylori antibodies may be done; however, this test is not recommended by major health organizations because it cannot distinguish a current infection from a past one. If positive, additional testing is usually required.

Tissue biopsy – this requires a procedure called an endoscopy (see below). Tissue is removed from the stomach during the endoscopy and may be examined under a microscope for the presence of active H. pylori infection, cultured, or tested for urease, the enzyme produced by the bacteria.

If the peptic ulcer is due to infection with Helicobacter pylori, treatment usually involves a combination of antibiotics to kill the bacteria and drugs to reduce the amount of stomach acid produced, such as proton pump inhibitors and histamine receptor blockers. A bismuth preparation such as Pepto-Bismol® may be prescribed to help coat ulcers and protect them from stomach acid.

Treatment can take several weeks; left untreated, peptic ulcers tend to recur and, in rare cases, can cause stomach cancer. Peptic ulcers are rarely fatal, but if they penetrate the stomach or intestinal wall (perforation), break a blood vessel (hemorrhage), or block food leaving the stomach (obstruction), they can be very serious.

Peptic ulcers are sores that develop in the lining of the esophagus, stomach, or upper section of the small intestine. Image credit: NIDDK

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

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National Digestive Diseases Information Clearinghouse (NDDIC). Sept 2014. What I need to know about Peptic Ulcer Disease. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/pepticulcers_ez/ through http://digestive.niddk.nih.gov. Accessed October 19, 2014.

MedlinePlus. Peptic Ulcer. July 2013. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000206.htm through http://www.nlm.nih.gov/. Accessed October 19, 2014.

National Digestive Diseases Information Clearinghouse. H. pylori and Peptic Ulcer. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/hpylori/ through http://digestive.niddk.nih.gov. Accessed August 2008.

American Academy of Family Physicians. Ulcers and H. pylori Infection. (Updated December 2006). Available online at http://familydoctor.org/online/famdocen/home/common/digestive/disorders/271.html through http://familydoctor.org. Accessed August 2008.